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How to Improve the outcome of Unidentified/ Unaccompanied Patient of Traumatic Brain Injury: An Institutional Study for Proposal of Framework

Manish Jaiswal, Assistant Professor, Department of Neurosurgery, King George’s Medical University,Lucknow, Uttar Pradesh 226003, India. , Manish Jaiswal1 , Somil Jaiswal2 , Bal Krishna Ojha3 , Sunil Kumar Singh4 , Anil Chandra5 , Chhitij Srivastava6

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International Journal of Neurology and Neurosurgery 10(2):p 113-117, April - June 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10218.7

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Abstract

Introduction: Management of unidentified and unaccompanied patients is difficult in any health care setup due to challenges in managing their daytoday care, treatment, and finally their rehabilitation as compared to patients having their attendants.

Aims & Objectives: This study was designed to collect data of unidentified & unaccompanied traumatic brain injured patients to prepare a framework for better outcome of these patients.

Patients and Methods: All unidentified and unaccompanied traumatic brain injured patients admitted in department of Neurosurgery, K.G.M.U., Lucknow from June 2015 to December 2017 (2.5 years) were enrolled in this study. We have devised various strategies to utilize the available infrastructure such as reserved the beds for these patients in the ward, allocation of designated fund for consumables, dedicated trained paramedical staff for nursing and care, enthusiastic multidisciplinary team of doctors for overall management during hospital stay, speeding the identification process through intense web based search of information available in Voter list & Aadhaar card. We do our our search on the basis of some clues gained during history taking of patient and daily rounds. Departmental staff, social workers, police and media personal help were taken for relocation of these patients to their home or non government organization shelter homes.

Results: There were 86 patients, 0.25% of all visits. Mortality was highest for polytrauma patients having severe traumatic brain injury (n=32, mortality= 68.7%), followed by moderate head injury (29, 41.3%) & mild head injury (25, 8%). Overall mortality was 41.8%. Outcome of these patients was comparable to patients who are accompanied by their relatives. Identification was made prior to hospital discharge in 96%. In this group, the most common source of information were the patient (40%, successful web based voter list search for home address in 12% of these cases), family (22%), or document eventually found on the person or belongings (8%). Survivors were much more likely to be identified than those who died (94% versus 83%, P less than .0001).

Conclusion: Comprehensive team approach of sensitized hospital staff, society and media is need for better management of unidentified and unaccompanied head injury patients. Web based Voter list search for home address is important digital tool helping in relocation. Framework development and strict adherence to strategies leads gratifying results.

Keywords: Unknown Patients; Traumatic Brain Injury; Unaccompanied patients. 

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DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10218.7

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